Ability of chest X-ray to detect faint shadows documented as ground-glass attenuation in images of computed tomography: A comparison between flat-panel detector radiography and film-screen radiography

Purpose: To compare flat-panel detector (FPD) radiography and film-screen (FS) radiography in detectability of faint shadows documented as ground-glass attenuation (GGA) areas in images of computed tomography (CT). Materials and methods: Study population was comprised of 50 patients who underwent FS and another 50 patients who underwent FPD. Standard of reference (SOR) was determined on the basis of area of GGA in all cross-sections of CT, in terms of GGA extent and presence or absence of GGA in each trisected lung fields (GGA distribution). Eight radiologists assessed the GGA extent with the 5-grade scale and the GGA distribution. Inter-observer variances of the GGA extents and distributions, degree of divergences and correspondence in the GGA extent and distributions with SOR, were compared between the FS and FPD by the jackknife method and Fisher's exact test. Results: Inter-observer variance in the GGA extent and distribution were slightly larger in the FS than in the FPD. The GGA extent scale corresponded with SOR in the FS statistically significantly better (p = 0.001), as the correct ratio was 0.428 in the FS and 0.310 in the FPD. Divergence in the GGA extent scale with SOR was smaller in the FS, as average kappa pseudo-value of Kendall's rank correlation coefficient was 0.474 in the FS and 0.433 in the FPD. Conclusion: These results indicate that some lesions of GGA documented in CT may not be reflected and are difficult to be detected in chest X-ray radiographs with the FPD.